Dydrogesterone use in early pregnancy

Abstract

Successful oocyte implantation and a favorable pregnancy outcome rely on optimal progesterone levels. Therefore, progesterone deficiencies associated with infertility and miscarriage have commonly been treated with progestogens that mimic the activity of progesterone. Among those is dydrogesterone, an oral retrosteroid with a structure closely related to that of progesterone yet with a greater bioavailability and higher selectivity for the progesterone receptor. This review describes the efficacy of dydrogesterone for the treatment of threatened and recurrent miscarriage, and infertility due to luteal phase insufficiency. Data from clinical trials evaluating dydrogesterone in assisted reproductive technology are also discussed. Prospective clinical trials, systematic reviews and meta-analyses have demonstrated that dydrogesterone significantly improves pregnancy outcomes in women with threatened miscarriage or with a history of miscarriage. Although this is not yet a registered indication, dydrogesterone was as effective as vaginal micronized progesterone for luteal phase support in the setting of assisted reproductive technology. The safety and tolerability of dydrogesterone treatment in pregnant women are also briefly addressed and the data support a well-established and favorable benefit-risk profile.

A Phase III randomized controlled trial comparing the efficacy, safety and tolerability of oral dydrogesterone versus micronized vaginal progesterone for luteal support in in vitro fertilization

“…Compared with progesterone, dydrogesterone has a greater affinity for the progesterone receptors and can be used at lower oral doses to promote endometrial proliferation, owing to its better bioavailability and to the progestogenic activity of its metabolites (Schindler et al ., 2008). Dydrogesterone also appears to have no affinity for androgenic, estrogenic, glucocorticoid or mineralocorticoid receptors (Schindler, 2009), demonstrating a favorable safety and tolerability profile in pregnancy, both to the mother and child (Queisser-Luft, 2009; Mirza et al ., 2016). Furthermore, data from prospective trials for luteal phase support in IVF show that oral dydrogesterone is as effective as micronized vaginal progesterone (MVP), is well tolerated overall, and has a higher patient satisfaction rate than MVP (Chakravarty et al ., 2005; Patki and Pawar, 2007; Ganesh et al ., 2011; Salehpour et al ., 2013; Tomic et al ., 2015; van der Linden et al ., 2015; Saharkhiz et al ., 2016).…”

Steroids, Pregnancy and Fetal Development

“…Additional evidence for an upstream role of progesterone in ameliorating the risk for pregnancy pathologies arise from more recent studies on progestogens supplementation during early pregnancy (3,106,107). Reduced progesterone, e.g., due to luteal insufficiency or stress may influence maternal tolerance toward fetal antigens and result in fetal loss (108,109).…”

Dose-Dependent Chlormadinone Acetate Can Suppress Premature LH Surge in Parallel with LH Value Reduction

“…But the safety of pharmacology for embryos in the case of MPA has not been confirmed. On the other hand, DYG is widely used as a treatment for improving pregnancy outcomes in women with threatened miscarriage (Howard et al, 2012;Mirza et al, 2016;Rizner et al, 2011). Previously, our clinic also prescribed DYG for PPOS.…”